NSAIDs and Heart Failure
April 28, 2009
Do you have a patient over sixty with a diagnosis of congestive heart failure taking a nonsteroidal anti-inflammatory drug (NSAID)? If so, be aware that their risk of hospitalization is increased by up to fifty percent of similar patients who do not take an NSAID.
In addition to heart failure, many over the counter pain relief drugs also cause blood pressure to rise, fluid to accumulate, and interfere with therapeutic aspirin. Although there is a small risk across the board of heart disease with NSAIDs, patients who already have a diagnosis of heart failure are at particular risk. Naproxen (Naprosyn and Aleve) increase the risk by 50 percent. Ibuprofen (Advil and Motrin), increase the risk of hospitalization in heart failure patients by 43 percent.
The controversy involving NSAIDs is hardly new. Many patients choose to live with an increased risk of heart failure instead of suffering the daily pain of severe arthritis. These patients are not the ones I am concerned about.
I am more concerned about the patients who have normal or occasional pain and take the first OTC pain reliever they find. How many patients do you have with heart failure with Ibuprofen ordered when Tylenol might have sufficed without increasing the risk of heart disease? When reviewing medications, try to identify patients who might benefit from Tylenol instead of NSAIDs and you may possibly avoid a hospitalization or two.
Information for this post was taken from WebMD. In the near future, expect to see more ways that you might reduce your hospitalization rate and improve the quality of life for patients with heart failure. When it comes time to implement OASIS-C or compare your agency’s acute hospitalization rate against your competitors, you will be in good shape!
If you have any questions or comments, please feel free to comment below or email us at haydelconsulting@bellsouth.net.
MO 770 OASIS Question about Telephone Usage
April 16, 2009
Recently on the Decision Health Home Care coding listserv a question was posed about MO770 – ability to use the telephone. The question sparked lively, intelligent debate and at the end of the day, I was on the fence about how the question should be answered for a patient with a laryngectomy who could use the text function on his telephone. My question to CMS as well the response is posted below.
On 4/15/09, we received the following email question: On a home health
listserv, a question has come up regarding the ability to use the
telephone. The original question was about a man with a laryngectomy
who was unable to speak. He was, however, able to use the text function
on his mobile telephone.
We are curious about how to answer MO770 for this patient. It was
pointed out by one listserv participant that text capabilities weren’t
even a consideration when the original data set was written. Can you
provide guidance?
CMS Response: M0770, Ability to Use Telephone, identifies the patient’s
ability to safely answer the phone, dial a number, and effectively use
the telephone to communicate. If a speech impaired patient can only
communicate using a phone equipped with texting functionality, response
“1″ able to use a specially adapted telephone would be selected.
Should you have any question about this, consult the Decision Health Listserv where you will find a lot of people just as confused as me.
Blind Spot
April 15, 2009
When examining OASIS data for large groups and comparing it to care plans, there is one major discrepancy that never fails to raise a red flag: having a large number of patients with identified visual impairments compared to the number of careplans and clinical notes that address visual acuity.
Do this for your next staff meeting or case conference or any other occasion when you call your nurses in. Buy a pair of the strongest reading glasses you can find at the dollar store. Bring the glasses along with three scavenged pill bottles, a potato and a veggie peeler and a photograph of someone famous. As a younger staff member who functions without corrective lenses to wear the glasses and choose the medication bottle of your choice. Have her try to peel a potato and identify the photograph. Ask her to dial a number on the office phone.
After you have had your fun (and I assure you that it is fun!), ask the nurse if her attitude towards vision has changed. Is it possible that she is even more empathetic towards patients with impaired vision after the demonstration than before?
Even patients who can read pill bottles and do not reach the criteria for impaired vision in MO390 may have their life greatly enhanced by improved vision. Being able to really appreciate a photograph of a grandchild or being able to read comfortably can greatly add to the quality of life.
Low Vision programs are great for the severely impaired. But many patients can benefit from the following simple, less complicated approaches to improving vision:
- Upon assessing a patient with impaired vision, obtain their eye doctor’s number and coordinate a visit for them if it has been over six months.
- Place PRN meds in large freezer bags and write the name of them on the freezer bag with a Sharpee so that patients can readily identify Lasix or PRN pain pills.
- Assign someone in your office to investigate what vision services are available through your state’s Medicaid program.
- Strategically place lamps where they will most benefit patients. Use the florescent bulbs that put out a lot of light and very little heat.
- Buy black handtowels or linen napkins for use while patients are taking meds. That way any pills that drop are easily found.
- Ask family members to assist in buying clocks, scales, phones, remote controls, etc., with large numbers. Suggest that recorded books are borrowed from the library to provide the patient with ‘reading’ materials if the patient enjoys books.
A Source for Patient Meds
April 8, 2009
Obviously, we spend a lot of time in the internet in our office looking up regs, updating the blog and following listservs. As a result, we have several favorite websites. One that I think everyone can benefit from is http://www.needymeds.org/.
On this website, you will find patient assistance applications for just about any drug you can imagine. When patients cannot afford medications, this is the place to go. It not only has the applications but the requirements for qualifying for assistance. Since many of the qualifying criteria involve a percentage of the federal poverty level, information is provided about the federal poverty level. And just to make life heavenly for viewers there is a list of free and discount clinics by area.
You can even realize a savings in your care delivery by using this service. It does not require the skills of an MSW to use this site. If the only need for an MSW your patient has is being unable to afford medications, consult this list first. MSWs provide an invaluable skill to our patients but when they are reduced to filling out forms, I wonder if they are over-utilized.
Many thanks to Dr. Richard Sagall and his crew for all the work that went into this service.
As always questions and comments can be addressed to us at haydelconsulting@bellsouth.com or left in the comment section below.
They Should Have Known!
April 5, 2009
While searching the internet in an unrelated issue, I stumbled upon the OIG page related to fraud and abuse in health care where false and fraudulent claims are listed. Below is what was reported regarding an organization called Shopko Stores in Utah. Notice that the OIG imposed a monetary penalty greater than a half a million dollars for employing someone that the organization ‘knew or should have known’ was excluded from the Medicare program. From the Office of Inspector General’s Fraud and Fraudulent Claim web page which can be found here.
After it self-disclosed conduct to the OIG, ShopKo Stores, Inc. (ShopKo), Utah, agreed to pay $669,824.74 for allegedly violating the Civil Monetary Penalties Law. The OIG alleged that ShopKo employed an individual that ShopKo knew or should have known was excluded from participation in Federal health care programs.
Since Medicare Providers are held to the standard of ‘what should be known’ in addition to what they actually know, reasonable diligence is expected. The surest way to protect your agency is to develop a comprehensive corporate compliance program. At the very least, agencies should check all employees and referral sources against the OIG exclusion database which can be found by accessing this link.
Haydel Consulting Services cheerfully assists agencies in developing their own corporate compliance plan. We are certainly less expensive than OIG imposed civil monetary penalties. Please feel free to contact us at 225-253-4876 or haydelconsulting@bellsouth.net.
